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Subtle elbow instability associated with lateral epicondylitis.

Sang Ho Kwak1, Seung-Jun Lee2, Hee Seok Jeong3

  • 1Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.

BMC Musculoskeletal Disorders
|May 9, 2018
PubMed
Summary

Subtle instability is present in some lateral epicondylitis cases, detectable via examination under anesthesia (EUA). Magnetic resonance imaging (MRI) can help rule out this instability, especially in patients with severe pain or prior corticosteroid injections.

Keywords:
ElbowEpicondylitisInstabilityLateralLigamentTendinosis

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Area of Science:

  • Orthopedic Surgery
  • Musculoskeletal Imaging
  • Sports Medicine

Background:

  • Lateral epicondylitis can present with subtle elbow instability, even without obvious signs on physical examination.
  • This instability may become apparent during examination under anesthesia (EUA).

Purpose of the Study:

  • To determine the prevalence of subtle instability in lateral epicondylitis patients undergoing EUA.
  • To assess the effectiveness of MRI in predicting subtle instability.
  • To identify preoperative clinical factors associated with subtle instability.

Main Methods:

  • One hundred twenty-two elbows with lateral epicondylitis underwent surgical treatment and EUA with fluoroscopy.
  • Patients were categorized into stable and unstable groups based on EUA findings.
  • Preoperative MRI scans and clinical data were retrospectively analyzed.

Main Results:

  • Subtle instability was detected in 13.9% of elbows during EUA.
  • MRI had a high negative predictive value (98.7%) for excluding instability but a lower positive predictive value (53.6%).
  • Higher preoperative visual analog scale scores and a history of multiple corticosteroid injections were associated with subtle instability.

Conclusions:

  • Subtle instability, often linked to lateral collateral ligament complex injury, is present in a subset of lateral epicondylitis cases.
  • Fluoroscopic EUA can visualize this subtle instability.
  • Preoperative MRI is valuable for ruling out subtle instability, guiding surgical considerations, particularly in patients with severe pain or multiple prior injections.